The last decade of research on opioid use disorder (OUD) has been a step in the wrong direction, as McLean (2021) mentions. Many researchers have come to common conclusions about substance users’ relationships with (and initial reactions to) consuming drugs. Though these researchers may understand that “users develop relationships with drugs that they wish to change but have difficulty doing,” they refrain from validating that narrative, which would help change common misconceptions held by the public. Even the concept of OUD, addiction as a “disease concept,” offers little benefit in understanding or relieving individuals of the drug-attributed struggles in their lives (McLean, 2021). The social autopsy of the opioid crisis in relation to North America is poorly framed as “a crisis of over-prescription” (McLean, 2021). This framing has unfortunate consequences for common institutional-level conceptions of this crisis. Within Alberta and British Columbia, provincial and municipal governments have taken the initiative to stigmatize and punish those who have “concurrent mental health and substance use disorders” (British Columbia’s Office of Human Rights, 2025). Through programs such as involuntary care, individuals are forced into abstinence and detention without consent, literally violating human rights in the process (Angie Stain, 2025). These punitive approaches only work to push those in need of help away from official channels and further impede the establishment of growth, development, or trust between individuals and institutions, complicating any route to recovery or security (Angie Stain, 2025). In BC, unregulated drug toxicity is the leading cause of death for people aged 19 to 59, and in Alberta, opioid overdoses occur within the ages of 15-59.

The dopamine hypothesis’s attempts to determine how addiction is perceived and known have externalized questions about users’ social conditions between prescribed opioid misuse and neurobiological addiction (substance use disorder, for example). Research labs attempt to interpret human-like relations to drugs by assessing the motivations and reward-seeking behaviours that make up “facets of the human condition”(Madigan et al.). This can be achieved through contingent and non-contingent models. Contingent models have been coined “the gold standard” for self-administration, best used in understanding the previously mentioned human condition. In comparison, non-contingent models are best used for testing the effects of intervention on subsequent behaviours and the impacts of environmental stimuli (Madigan et al.). The conditioned place preference model helps researchers learn about the contextual environments' impacts on an individual's tolerance and neurological responses in the case of opioid overdoses and unregulated drug poisonings (Madigan et al.).

Recently, the Alberta government removed individuals' access to safe supply and re-classified smoking pipes as “not a harm reduction material,” thus cutting off substance users from official channels to clean and safe consumption materials (Angie Stain, 2025). Due to this change, individuals are steered towards relying on haphazard innovation and unclean practices, which increases the risk of contracting STDs (4B Harm Reduction Society, 2025). Angie Stain, founder of 4B Harm and a neuro E.R. nurse, has been a wealth of information in this research. When asked about current brain oximeter machines in-house, she explained that in many overdose response cases, she already knew of the machine’s utility for live tracking of healthy brain oxygenation, yet faced resistance to using them outside of the respiratory wing of the hospitals she worked in (2025). Brain oximetry would be more effective than pulse oximeters for assessing substance for a few reasons: The usual method to read a patient's pulse vitals can be difficult with houseless populations whose hands have been exposed to hypothermia, killing off blood cells and making circulation readings unreliable (Angie Stain, 2025). Another is how “community members who inject opioids into the base of their thumbs also do not offer effective pulse readings, as the swelling reduces pulse oximeters' effectiveness.

Due to the opioids' effects as a “downer” or neuronal inhibitor, we see users' brain activity drop as they enter a state of stupor or “sleep.” Due to the current supply, many community members are described to be instantly hit with the high, quickly entering that stupor, even involuntarily. We can use recent revelations about the vegetative state to compare it with brain activity and the sense of consciousness. According to Adrian Owen’s “Detecting Awareness in the Vegetative State,” those who suffer from this disorder were used to measure neural responses to spoken sentences compared to acoustically matched noise sequences (e.g., “there was milk and sugar in his coffee”) (detecting awareness in the vegetative state). This study uses fMRI to compare the middle and superior temporal gyri in healthy volunteers and in vegetative patients performing the same task.

During a second fMRI study, patients were instructed to perform two mental imagery tasks at specific points in the scan. One involved imagining visiting all the rooms in their house, which resulted in both groups showcasing indistinguishable brain activity in the parahippocampal gyrus, posterior parietal cortex, and the lateral premotor cortex (Fig. 1). All of this activity points to patients who meet clinical criteria for a diagnosis of vegetative state also retain the capacity to understand spoken commands and respond to them through brain activity (Detecting awareness). Regarding the context in which our proposed technology would be used, it becomes evident that considerations for measuring brain activity might benefit paramedics in communicating and supporting patients to return to a more homeostatic state, where they are not at risk of dying from overdose or drug poisoning. Particularly, 4B Harm usually finds individuals needing queues to breathe (Angie Stain, 2025), so acknowledging one's neural activity can determine the effectiveness and, preliminarily, distinguish the degree of the poisoning through these methods.

This project requires the hybridization of EEG and fNIRS systems through a corded device for the sake of resiliency and cost reduction. These cords will attach to a central rectangular console for medical measurement by both modalities. This console will retain a coloured screen that showcases brain oscillations in the center, and records brain oxygenation percentages in the top right corner (see Fig. 1). Due to the time constraints paramedics will face, a dry-electrode EEG system will be most optimal. Furthermore, an fNIRS system has proven to offer various benefits due to its safety, known portability, and relatively inexpensive fabrication. It has become a more centralized tool for assessing cognitive function in critical care settings at hospitals(Kazazian et al., 2024). These developments are thanks in part to the work of Adrian Owen’s studies on the vegetative state, especially when furthering researchers’ understandings of cognition in critical care patients(Kazazian et al., 2024).

The common physics of brain oximetry utilizes light within the infrared range from a fibreoptic light source and light detectors to assess how it traverses through skin, tissue, and bones before striking “metal complex chromosphores,” or hemoglobin (Tosh & Pateril, 2016). The generic machine abides by the Beer-Lambert law on how light traverses these substances and how it reflects: Beer’s law explains that the intensity of light decreases exponentially as the concentration of the substance it passes through increases (Tosh & Pateril, 2016). This helps us interpret how oxygen concentrations in hemoglobin molecules reflect infrared light to the detectors. Meanwhile, Lambert's law argues that the intensity by which light decreases is exponential as the distance travelled increases (Tosh & Pateril, 2016). This determines the general location of neural activity as oxygenated hemoglobin is directed to the relevant sites.

Using a similar design to the Portalite MKII sensor design(Artinis Medical Systems, 2025), the device will include a central pod with one satellite pod on either side. These pods will be made of a flexible and semi-rigid plastic, connected to the device by a similarly designed cord (see Fig. 5). The intention to include cerebral oximetry is due to its capability to obtain live measurements of cerebral oxygenation. This monitor is connected to oximeter probes, or “optodes” (Tosh & Pateril, 2016). These optodes will be directed to the Frontal Polar sections of the patient's head, with the central pod at the center of their forehead, aptly named FPx for simultaneously functioning as a EEG point of reference. The central pod will be slightly larger to compensate for its superimposition with the EEG reference node (see Fig. 6). Ideally, both systems should work simultaneously to offer the best readings on a patient’s condition.

Using portable fNIRS systems in medical contexts will be a new revelation for healthcare systems; in the paramedic context, cerebral oximetry requires recording baseline values to determine an individual's condition. This impact is being reconsidered in light of new developments in Event-Related Optical Signalling (EROS), which improve hemodynamic measurement speeds to millisecond precision (Mathewson-Lecture 6, 2025). Hybridization is best utilized in this case as “EROS measures physical changes in neural tissue… as it swells by about 1-2% as ions rush across the cell membranes” (Mathewson-Lecture 6, 2025). That, accompanied by “membrane reorganization, opens a 10-100 millisecond window for photon paths to travel more directly, resulting in earlier photon detection” (Mathewson-Lecture 6, 2025). While standardized values sit in the range from 60% - 80%, 55% - 60% is not abnormal for certain cardiac patients(Tosh & Pateril, 2025). EROS, justified by the new revelations by Kazazian et al., showcases the capacity to identify not only brain oxygenation but also more precise activity without the need for reference data.

This information allows us to diversify paramedic practice and assessments according to opioid overdose and drug poisoning cases. With this, we have the justification of bringing motor direction into response practice, queuing the behaviour to breathe should the patient be neurally responsive. Extensive research into the condition caused by drug poisonings should be studied, and this device has the capacity to turn real-life situations into a life-saving tool and a research contraption capable of recording two modalities. In conclusion, this device will be capable of assisting in various aspects of research and clinical practice, allowing us to be more objective and responsible for houseless communities in Edmonton and at large. Everyone deserves respect and dignity, which has been sorely lacking with recent legislation and current attitudes towards these populations.

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